Cause of Dry Mouth, Investigations and 12 Best Possible Treatment Options; Clinical Problem Solving

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Cause of Dry Mouth, Investigation and Treatment; Clinical Problem Solving; dry mouth, one of the most common problems reported in the clinic. Although a very common sign and symptoms it can be associated with many other diseases which might be challenging to solve the case of dry mouth. Many oral and systemic history as well as examinations should be considered for correct diagnosis of the disease and plan the treatment accordingly.

Cause of Dry Mouth, Investigation and Treatment

In this case study we have included detailed history of the case as well as clinical, laboratory and histopathological examinations that are needed for correct diagnosis and treatment. Case: A 47-year-old female presents to the clinic complaining of dry mouth.

Chief Complaint: Patient complains of dryness of mouth since 3 years ago. 

History of presenting Illness:

She first noticed the dry mouth about 4 or 5 years ago. At first it was only an intermittent problem but over the last 2 years the dryness of mouth  has become constant. The dryness of mouth has made her very uncomfortable and affects

eating and speech..  Recently the mouth has become sore as well as dry.

Medical History: Patient has no relevant medical history. No history of drug consumption is present.(Drugs are by far the commonest cause of xerostomia)

Dental History: Restoration of anterior teeth 5 years back.

Personal History: She has no habit of chewing tobacco or smoking or alcohol consumption. Mouth breathing habit is also absent.

Examination:

  • Extra-oral examination:
    • Bilaterally symmetrical face
    • No detectable cervical lymphadenopathy.
    • parotid glands and the submandibular glands appear normal on bimanual palpation
  • Intraoral examination:
    • The gingiva appears reddish and “glazed” and atrophic.
    • The tongue is lobulated and fissured.
    • The tongue shows reddish in color and slightly swollen.
    • There are carious lesions at the cervical margins of the lower anterior teeth(indicate high caries rate).
    • No saliva pooling is seen on the floor of the mouth 
    • frothy and thick saliva (All these intraoral features suggest long term xerostomia)
cause-of-dry-mouth-and-its-treatment

Possible Diagnosis:

True Xerostomia:

  1. Drugs
  2. Dehydration
  3. Sjögren’s syndrome
  4. Irradiation
  5. Neurological
  6. Developmental anomaly

False Xerostomia:

  1. Mouth breathing
  2. Mucosal disease
  3. Psychological

Among these, most possible diagnosis on the basis of history, signs and symptoms is Sjögren’s syndrome.

INVESTIGATION of Dry Mouth:

  1. Salivary flow rate: When measured the flow, the patient has a whole salivary flow rate of 0.1 ml/minute. (0.2 ml/minute) unstimulated whole saliva flow is generally considered to indicate xerostomia.)
  2. Culture for candidal count: A dry mouth is not usually sore unless there is superimposed candidal infection. Smears, a saliva sample of antifungal agents are required to exclude this possibility.
  3. Salivary gland:
  • Schirmer test: This measures lacrimal secretion because dryness of the eye is also other symptoms of this disease. 
Cause-of-Dry-Mouth-Investigation-sialography
  • Sialogram: Sialogram almost always shows characteristic changes 

The sialogram shows sialectasis. The major duct is seen but almost no major or minor duct branches are visible. Small round spots of contrast medium are scattered throughout the gland, apparently unconnected with the duct tree.(Salt and pepper appearance or Snow storm appearance)

Final Diagnosis:

cause-of-dry-mouth-investigation-and-treatment

Primary Sjögren’s syndrome

Treatment of Dry Mouth:

  1. Treat candidiasis if present. 
  2. Saliva is very necessary in this condition so retention of saliva is primary goal. 
  3. Sip water rather than drinking it, so as to expand remaining saliva and not wash it from the mouth.
  4. Maintain fluid intake.
  5. Stimulate residual salivary flow using chewing gum (sugar-free).
  6. Whenever possible avoid drugs which cause xerostomia.
  7. Consider using pilocarpine in severe cases.
  8. Prevent and treat dental caries
  9. Avoid sweets or overuse of citrus fruit to stimulate salivary flow.
  10. Appropriate dietary analysis, preventive advice and fluoride treatment.
  11. Treat caries.
  12. Ensure continued ophthalmological follow up.
  13. Warn patients and follow up for development of persistent salivary gland swelling.

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